Safety, feasibility, and efficacy of surgical intervention for Urolithiasis in patients with chronic kidney disease: A systematic review.

Abstract

Background: Urolithiasisposes challenges in patients with chronic kidney disease (CKD), necessitating careful consideration of surgical interventions due to potential complications.

Aim: To assess the safety, feasibility, and efficacy of surgical interventions for urolithiasis in CKD patients.

Methods: Systematic review adhering to PRISMA guidelines. Comprehensive searches of PubMed, Scopus, Cochrane Library, Web of Science, and Embase were conducted for studies published from January 2014 to June 2024. Studies involving adult patients (≥ 18 years) with CKD undergoing surgical interventions for urolithiasis, including randomized controlled trials, cohort studies, case-control studies, and observational studies. Studies involving pediatric patients, those not specifically addressing CKD patients, review articles, commentaries, and editorials. Despite an extensive search, only six studies met the strict inclusion criteria, reflecting the limited available data on this topic. This limitation has been acknowledged and discussed.

Results: A total of 6 studies met the inclusion criteria, encompassing a diverse range of surgical interventions such as percutaneous nephrolithotomy (PCNL), ureteroscopy (URS), and extracorporeal shock wave lithotripsy (ESWL). Perioperative and postoperative complications varied across studies, with bleeding, infection, and acute kidney injury being the most common. The risk of complications was higher in patients with advanced CKD. Technical success rates were generally high, but feasibility was influenced by patient-specific factors such as CKD stage and comorbidities. Modifications to standard surgical techniques were often necessary. Stone-free rates and recurrence rates varied, with PCNL generally achieving higher stone-free rates compared to URS and ESWL. Long-term outcomes on renal function were inconsistent, highlighting the need for individualized treatment plans.

Conclusion: Surgical interventions for urolithiasis in CKD patients are associated with significant risks but can be effective in achieving stone clearance and symptom relief. The safety, feasibility, and efficacy of these interventions depend on patient-specific factors, necessitating a tailored approach. Further high-quality studies are needed to develop standardized guidelines and improve clinical outcomes in this complex patient population.